Federal Tax Extension Confirmation 1516 printable pdf download

Federal Tax Extension Confirmation 1516

354 Richards Hall

fax: 617.373.8735

360 Huntington Ave

email: sfs@neu.edu

Boston, MA 02115

2015-2016 Federal Tax Extension Confirmation

Student’s Name: _______________________

NU ID: ______________________

You were asked to submit this form because you informed us that you (or your parents)

filed an IRS Form 4868, ‘‘Application for Automatic Extension of Time to File U.S.

Individual Income Tax Return’’.

Name(s) of an individual(s) for whom the extension was filed:

1. ________________________

2. __________________________

Self-employed?  Yes

No

Self-employed?  Yes

No

Wages earned by the above individual(s) for tax year 2014: $_______________________

Estimated Adjusted Gross Income for the above individual(s) for tax year 2014: $______

Estimated U.S. income tax paid for the above individual for tax year 2014: $__________

Along with this form, please submit:

 A copy of the IRS’s approval of an extension (IRS Form 4868).



A copy of all W–2(s) for each source of employment income received for each

individual named above for tax year 2014, if applicable.

Certification

By signing this form, I certify that I filed an IRS Form 4868, “Application for Automatic Extension

of Time to File U.S. Individual Income Tax Return” and that all of the information reported on this

form is complete and accurate.

Name (Please Print): _______________________________________________________________

Signature: ________________________________________

Date: _______________

Federal Tax Extension Confirmation 1516